Psychology & Humanitarian Assistance

Civil conflict, natural disasters, pandemic disease and famine continue to place the work of humanitarian assistance high in public consciousness. The last twenty years have seen a concerted attempt by humanitarian agencies – both non-governmental and inter-governmental – to develop best professional practice in their fields of operation. The current work of such agencies bears the clear mark of contribution from many disciplines, ranging from agricultural to management sciences, from macroeconomics to social anthropology, from engineering to medicine. However, the contribution from psychology has, to date, been modest.

There are, however, signs of this circumstance changing, with psychologists beginning to make contributions in a number of areas of activity. The purpose of this paper is to (1) identify the constraints that have limited the previous contribution of psychology in the arena of humanitarian assistance and (2) map areas where contributions have begun to be made, or offer particular potential for future contribution. The broad assertion of the paper is that the obstacles to appropriate application of psychological knowledge in the furtherance of the work of humanitarian assistance agencies are very real but, with due sensitivity, flexibility and breadth of vision, there are many areas of the discipline of psychology – both pure and applied – that can make a meaningful contribution to the conceptualization and implementation of humanitarian assistance.

The Field of Humanitarian Assistance

While charitable works supporting groups who have been the victims of natural disaster or conflict have a history of many centuries, the roots of the current global humanitarian regime can be traced back to the period immediately following World War II (Smillie & Helmich, 1993). In this period a number of agencies, such as CARE and Oxfam began their work in organized relief amongst war-affected populations. What began as work focused narrowly on food relief and emergency medical assistance steadily grew to address broader issues supporting the social and economic development of communities. As the remit of humanitarian agencies broadened – and the complexity of the tasks they faced – humanitarian agencies became increasingly professional in their working practices. Professionalism has gradually displaced volunteerism as the dominant value system of humanitarian organizations, and it is now appropriate – and in no way pejorative – to talk of the humanitarian world as a discrete ‘industry’ (Zetter, 1999) with its defined, goals, methods and intended products.

It is an industry, however, with a close relationship to the world of politics and international relations. The majority of humanitarian agencies working in this area are generally termed ‘non-governmental organizations’ (NGOs), noting their separation from government authority. Such organizations can range from small local groups to major international agencies working in more than 50 countries across the world. While defined by their separation from government many of these agencies – particularly the larger ones – generally share close working ties with governmental (such as the US Agency for International Development and Canadian International Development Agency) and inter-governmental agencies (such the United Nations High Commissioner for Refugees and United Nations Children’s Fund). While most NGOs still seek significant funds directly from public charitable giving, the operational work of such organizations is often heavily dependent on securing funding from donor governmental or inter-governmental agencies for specific programs (Hulme & Edwards, 1997). While humanitarian agencies clearly seek relief of suffering and support to populations in crisis, much of their assistance is geared towards longer-term development goals and reflects inter-governmental and governmental policies with respect to such issues as poverty elimination, governance, gender equity and sustainable development. By way of illustration, each month the UN’s Office for the Coordination of Humanitarian Affairs holds a briefing meeting for NGOs and other agencies in New York regarding current foci of humanitarian concern, reviewing and coordinating response in settings which have recently included West Africa, Sudan, Southern Africa, Iraq, Chechnya and Afghanistan. Thus although humanitarian work retains a foundation in charitable support, the breadth and complexity of humanitarian activities has grown to assume a truly global significance with respect to economic development, regional security and international relations.

As humanitarian agencies have ‘professionalised’ over the last twenty years, a wide range of disciplines have come to shape these organizations and their work. Acknowledging the relationship between living conditions and the economic development of nations, agencies have become increasingly sophisticated in their understanding of – and relationship with – economic analyses at both macro- and micro- levels (Nafzinger et al., 2001). Underpinning the efficiency of interventions in such areas as public health and nutrition, agricultural development, and water and sanitation there is generally significant input from specialist technical advisors ensuring that activities reflect evidence-based best practice (e.g. Toole, 2002) and meet universal minimum standards (The Sphere Project, 2000, 2004). In professionalizing management practices, many agencies have specifically recruited management professionals from the commercial world to introduce strategic planning, marketing, stock control and HR practices that reflect current thinking within the management sciences (Fyvie, 2002). Acknowledging the importance to the effectiveness of humanitarian assistance of contextualized understandings of local communities and their constructions of need has led to significant investment in deploying social anthropologically-informed methods of assessment and appraisal for both project design and evaluation (e.g. Zwi et al., 2002).

In contrast, psychological knowledge and analysis has to date had little impact on the work of humanitarian agencies. Although there are some signs that this is changing, evidence from recruitment literature and employment practice reinforces the view that agencies generally do not see the skills and perspectives of psychologists as relevant to their work. It is clearly important to consider the real and perceived constraints on the role of psychology in supporting humanitarian work before considering how this situation may be addressed.

Constraints on the Role of Psychology

While a number of constraints on the role of psychology within humanitarian work may be identified, the analysis here focuses on three factors that may be seen to be the most significant in limiting the contribution of the discipline in this area to date.

Uncertain developmental relevance

As the sophistication of humanitarian work has grown, so has the conceptual analysis upon which it has based. While in the immediate post-World War II years assistance was generally based upon basic notions of relief (Werner, 2001), development studies has subsequently evolved as a multi-disciplinary area informing humanitarian and development assistance strategy with respect to the complex interactions of environmental, economic, social and cultural forces in shaping national and regional development. Increasingly ‘disasters’ and ‘complex emergencies’ are not being seen as discrete ‘crises’ but symptoms of broader issues that need to be analyzed and tackled with a developmental perspective (Stewart & Fitzgerald, 2001). While the frameworks adopted for such analysis generally draw heavily upon the disciplines of economics, sociology, social anthropology and political science, they make little use of psychological formulations.

There is little in the way of empirical research to confirm why this is the case, but from a series of recent case studies (e.g. Fyvie, 2002; Loughry & Ager, 2001) it appears that humanitarian workers and development theorists alike find it hard to integrate psychological knowledge into the broader social science accounts that form the core of their discourse. Psychology is perceived, principally, to be concerned with the behavior of individuals, while the humanitarian agency typically works with respect to beneficiary populations running to tens, or possibly, hundreds of thousands. Psychology is also perceived to locate the determinants of behavior in internal events of the mind, while the agency seeks to identify key issues in the environment that are amenable to influence. While these perceptions may be seen to be something of a caricature, they are potentially influential – not least, perhaps, within the discipline of psychology itself.

Cultural specificity

Another factor frequently cited by humanitarian workers as constraining the assumed relevance of psychological analysis to humanitarian assistance is the ‘cultural specificity’ of the discipline’s analyses. Within the discipline itself it is not unfamiliar to find such assertions as:

‘psychology…imposes Western European and North American values world-wide in a form of cultural imperialism which is as invidious as any other…the psychology on offer is, at best, the indigenous psychology of White Western people within highly industrialized nations’ (Owusu-Bempah and Howitt, 2000, p. 5).

Such critique not only challenges the validity and utility of psychological analysis in the cultures of the developing world, of course, it also challenges the appropriateness of psychological analysis in the increasingly multicultural contexts of Western societies.

Given consistent evidence of the varying cultural construction of core psychological concepts such as self, normality and well-being (Berry et al., 1992) it is impossible to argue for the straightforward universal generality of psychological analysis. Essentially, we are forced to see psychological analysis as inevitably culture bound and determined by local custom, meaning and belief (sometimes referred to as an emic or indigenous psychology approach) or as generalizable only to the extent verified by thorough empirical analysis (a derived etic approach). In truth, this debate goes back to the founding work of modern psychology in work of Wundt, who envisioned two components of the discipline (see Owusu-Bempah and Howitt, 2000): one modeled on the natural sciences (for considering basic operations underlying such processes as consciousness) and one modeled on the cultural sciences (for considering human experience as determined by language, custom and myth). For those who see the first component as the core of the discipline it is clear that, at the very least, there is an obligation to demonstrate the generalizability and validity of formulations across cultures rather than to lazily (and often inappropriately) assume it. Our own work has shown how formulations of psychological processes initially derived from Western contexts can variously be shown to be remarkably coherent with – or on other occasions spectacularly discrepant with – local constructions (MacLachlan et al., 1996; Ager & MacLachlan, 1998; Loughry, 2003).

Limited global representation

Notwithstanding potential conceptual defense of the developmental relevance and cultural validity of psychology regarding humanitarian activity, the case for the global utility of the discipline is clearly compromised if it is essentially based on the judgements of people drawn from one region of the world of the value of their own work in other regions. As Berry et al. (1993) suggest:

The rest of the world has often assumed the roles of ‘consumers’ or ‘subjects’; psychology is ‘sold to’ or ‘tried out on’ other peoples (p. 378).

This asymmetry is at the heart of many of the disputes regarding the place of psychology in the developing world (see Blackler, 1983; Carr & MacLachlan, 1993; Owusu-Bempah & Howitt, 1993). It is impossible to separate the conceptual discussion of the applicability of psychological analysis in particular settings from the maldistribution of labor in psychology, which sees such a significant imbalance in representation of psychological knowledge between the ‘northern’ Euro-American base of the principle humanitarian and inter-governmental actors and the ‘southern’ focus of the majority of humanitarian crises.

Organizations such as the International Association of Applied Psychology (IAAP) and the International Union of Psychological Science (IUPsyS) have recognized it as a major challenge to facilitate active participation of psychologists from ‘southern’ countries to seek to redress the balance in the global discourse of psychology. The problem relates partly to the limited numbers of psychologists with postgraduate qualification in many developing nations, and partly to the severe resource constraints, which limit psychologists from such nations travelling to international meetings. Limited library and IT facilities further constrain the potential for developing world psychologists to influence and inform global debates. However, broader factors than resource constraints alone have limited the influence of psychologists from lower income nations on the global discipline of psychology. Limited investment in postgraduate psychology in many developing nations – linked in part with perceptions of the limited developmental relevance of the subject – has meant that people have often had to travel to America, Europe or Australia for further training in the discipline. While some academic centers have had a strong awareness of the need to rigorously address the cultural context of psychological study for such students, many have not. Psychologists can thus return to their home country with training in research methodologies and theoretical models more suited to their place of study that their place of future practice, and thereby risking the uncritical importation of assumptions of questionable utility.

Experience within India, which has by far the largest number of psychologists within any nation of the developing world, suggests that the issues of representation, cultural generality and developmental relevance are somewhat interrelated. As the cadre of qualified psychologists within the country has grown there has been a move from the straightforward ‘importation’ of models and theories from the West, through a period characterized by greater indigenization of theorization and methods, to a state where the discipline is self-confident in its judgement of the cultural relevance of formulations (of whatever initial origin) to the local context and the goals of national development (Berry et al., 1993).

Towards a psychology of humanitarian assistance

The above analysis suggests that, although uncertain developmental relevance, cultural specificity and limited global representation have been very real constraints on the role of psychology in informing humanitarian assistance, they do not represent barriers that are insurmountable. Indeed, recent years have seen very promising developments in psychology contributing to analysis of humanitarian need as the discipline grapples with these issues. This paper concludes with some illustrations of such developments.

Children’s Mental Health in the Context of War and Conflict

The suffering of children in the context of war has been a focus of humanitarian concern for over fifty years (Werner, 2001), but it has only been within the last decade that awareness of the developmental consequences of such experience have significantly influenced humanitarian action. The shift from a focus on ‘child survival’ to ‘child survival and development’ in this period has been marked, and psychology has played a significant role in supporting this change.

The notion of trauma has been of significant influence in this period, though the issue of the cultural specificity of this concept has been the focus of much debate. It was not until 1987 in the revised edition, the DSM-IIIR, that there was any reference to children and post-traumatic stress disorder (PTSD). While debate ensued about the applicability of the diagnosis of PTSD to children in general, PTSD was quickly viewed as a new framework from which to explain the behaviour of war affected and refugee children after exposure to stressful events experienced in events of disaster and war. Measures such as the Child Behaviour Inventory (CBI) (Macksoud, 1992), developed to assess behaviour problems thought to be culturally relevant across a range of cultural settings, led to trauma research being conducted with large samples in settings of on-going conflict.

Recent studies concerning the Balkans conflict and the Rwandan genocide illustrate a now established trend of work estimating the number of traumatic events children have been exposed to and the resulting number of traumatised children (Dyregov et al., 2000; Smith et al., 2002). These data have been used to inform the public about the harmful affects of war, donors about the need to assist ‘victims’ of war, and humanitarian agencies about the need for clinical interventions in war and refugee settings.

De Jong (2002), summarising the work of the Trancultural Psychosocial Organisation in a number of war-affected countries, noted the variation in traumatic stressors – ranging from separation from parents, witnessing of killings, bereavement and deprivation of basic needs – faced by children in circumstances of war. The psychological consequences of exposure to traumatic stressors also appeared to vary widely. Estimates of PTSD among children exposed to political conflict in the areas review by de Jong ranged from 9% to 90% (de Jong, 2002).

Yule (2001) supports this form of analysis, suggesting that a year after exposure to major trauma as many as 50% of children may be expected to show psychological distress. He suggests, however, that much of this vulnerability may be attributed to the disruption of personal and community resources through displacement and on-going conflict. Citing the data collected in the former Yugoslavia by UNICEF (Stuvland, 1994), Yule notes how in political conflicts there is frequently a complex entanglement of multiple events, including ethnic cleansing, family break-ups and forced relocation (Yule, Perrin & Joseph, 1999), all serving to erode coping resources.

As psychologists have become increasingly involved in the planning of humanitarian interventions in such contexts (e.g. Boothby, 1996; Wessells and Monteiro,2000) there is increasing agreement that a focus on PTSD itself does not represent a suitably comprehensive account of such experience. This is partly in response to critiques (e.g. Summerfield, 1999; Bracken & Petty, 1998) that have questioned the applicability of the diagnosis PTSD to non-Western populations and the potential ‘pathologising’ of large populations. It is also, however, a more general acknowledgement of the important of conceptualising mental health needs within the context of personal coping resources, family functioning and broader community resources (Hobfoll, 1998).

Recently, the Psychosocial Working Group, representing a collaboration between a number of academic centres and humanitarian agencies (www.forcedmigration.org/psychosocial), have sought to develop a conceptual framework which integrates the concept of traumatic stress within a broader analysis of the personal, familial and community disruptions associated with violent conflict (Ager, 2002). This suggests that the mental health of individuals forms an important element of the human capacity of a population engaging in recovery, but that overall psychosocial well-being is sustained by the engagement of such human capacity with the social ecology and culture and values of the community. The domains of human capacity, social ecology, and culture and values each represent areas of resource potentially depleted in the course of humanitarian crises, and thus potential routes of intervention in support of psychosocial well-being (PWG, 2004). Such formulations represent a maturing of psychological analysis equipped for dialogue and integration with broader discourse within humanitarian work.

Social Psychology of Ethnopolitical Conflict

Given the role of ethnopolitical conflict in the origins and maintenance of many contemporary conflicts and crises, intergroup relations is clearly a field of study of major potential significance for humanitarian efforts. Up until recent times, however, the barriers identified earlier appear to have restricted the development of psychological formulations of direct relevance to conflict resolution and post-conflict recovery. Post conflicts in Rwanda, former Yugoslavia, East Timor, Afghanistan etc., these themes have begun to be informed by discrete psychological analysis. Mays et al. (1998), in an International Perspectives Special Section of American Psychologist, documented the potential for psychologists to inform analysis and intervention across a range of sites of ethnopolitical tension. The establishment of the Solomon Asch Center for the Study of Ethno-Political Conflict at the University of Pennsylvania in 1999 – an initiative supported by both the American and Canadian Psychological Associations (APA and CPA) – provides further tangible evidence of such developments.

Given clear evidence for the development of ethnic stereotyping through childhood, children have been a common focus for initiatives to combat cross-ethnic prejudice (Kostarova-Unkovska & Pankovska, 1993). Such programmes have often been informed by versions of the ‘contact hypothesis’ suggesting that social exposure to members of other ethnic groups reduces prejudice and hostility (Cairns & Darby, 1998). Work on inter-group behaviour shows particular promise, however, as mainstream psychological research on factors influencing ‘in-group’ and ‘out-group’ behavior and attributions begins to be applied in the analysis of ethnopolitical conflict (e.g. Bar-Tal, 1996; Hewstone et al., 2002).

Mays’ et al. (1998) review noted the complexities and challenges for psychology within this arena if it is to be used to capture the voice of the oppressed and vulnerable rather than the agendas of the powerful. Developments within peace psychology, however, suggest that psychology is managing to work through some of the tensions of addressing situations where a ‘balanced’ de-politicised analysis would not reflect the ethnopolitical inequalities maintaining conflict (Bretherton, 1996; Wessells & Bretherton, 2000).

Analysis and Support of Non-Governmental Organisations

Given the importance of NGOs as vehicles for humanitarian assistance, such organisations have – until recent times – been a remarkably neglected area of psychological analysis. However, psychological support for humanitarian aid workers – and its relevance for the effectiveness of their agencies – has now become a major focus of work for members of the discipline. Recent years have seen a move in the literature from advocacy for the psychological needs of humanitarian workers working in challenging circumstances (e.g. Smith et al., 1996) to empirical analyses of risk and resilience factors (e.g. Lopes Cardozo & Salama, 2002; Erikson et al., 2001) and the documentation of strategies for staff support. It appears that there is a clear ‘dose response’ relationship between experience of trauma events and anxiety symptoms of clinical significance. Further, indicating the mediating role of personal coping resources, vulnerability is greatest for those workers either on their first assignment or with a long history of serial deployments. It is also now clear that NGOs can potentially – through selection, training or management practice – do much to address such risks (Ager et al, 2002; Antares, 2002).

Work on stress in humanitarian workers has led to closer examination of the culture and operation of NGOs from an organisational perspective. NGOs generally seek to the retain humanitarian values, local networking and flexibility associated with their charitable goals, yet are increasingly seeking greater efficiency and effectiveness through utilisation of expertise from the private-for-profit sector (Hulme & Edwards 1997). NGOs generally see the capacity for innovation as a key feature of their comparative advantage, though studies have shown the many constraints – internal and external to these organisations- that can mitigate against this (Fyvie & Ager, 1999). Principles of organisational psychology are thus increasingly seen as relevant for assisting NGOs in delivering their programs (Fyvie, 2002).

In three thematic areas moves towards the establishment of a psychology of humanitarian assistance has been illustrated. It is clear that in each area established psychological concepts and formulations – borne of work in other settings and with other populations – offer an initial foundation for the development of analysis of humanitarian assistance. Rigorous responses to the challenges of uncertain developmental relevance, cultural specificity and limited global representation – are leading to the development of a new and crucial area of psychological enquiry and practice. The recent inclusion of the need for social and mental health services in the revised addition of the Sphere Handbook (2004) adds to the urgency for this development as NGOs and funding bodies explore how best to shape these services within the field of humanitarian assistance.

Ager, A, Flapper, E, van Pietersom, T & Simon, W (2002) Supporting and equipping national and international humanitarian non-governmental organisations and their workers. In Y. Danieli (ed) Sharing the Front Line and the Back Hills: Peacekeepers, Humanitarian Aid Workers and the Media in the Midst of Crisis. (pp. 194-200). New York: Baywood.

The Antares Foundation (2002) Report of the Second Conference on Stress in Humanitarian Workers, Amsterdam, September 2002. Amsterdam: Antares/Center for Disease Control.

Bar-Tal, D. (1996) Development of social categories and stereotypes in early childhood: the case of “the Arab” concept formation, stereotype and attitudes by Jewish children in Israel, International Journal of Intercultural Relations, 20 (2/4): 341-70.

Boothby, N. (1996). Mobilizing Communities to Meet the Psychosocial Needs of Children in War and Refugee Crises. In R. J. Apfel and B. Simon (Eds.) Minefields in their Hearts. New Haven, Yale University Press.

Kostarova-Unkovska, L & Pankovska, V (1993). Children Hurt By War. General Children’s Consulate of the Republic of Macedonia.

Lopes Cardozo, B & Salama, P (2002). Mental health of humanitarian aid workers in complex emergencies. In Y. Danieli (ed) Sharing the Front Line and the Back Hills: Peacekeepers, Humanitarian Aid Workers and the Media in the Midst of Crisis. (pp. 242-255). New York: Baywood.

Loughry, M. (2003). The psychological well-being of former unaccompanied asylum seeking children after their return to Vietnam. Unpublished Doctoral Dissertation, Flinders University of South Australia.